LITHOTKITY. 



567 



ated by any competent instru- 

 ment-maker. 



"WTiile they must necessa- 

 rily possess sufficient power to 

 crush the calcuH, we fail to see 

 that a proper attention to the 

 features of symmetry, finish, 

 and convenience of manipula- 

 tion can involve any sacrifice 

 of efficiency. The instrument 

 can be made to possess amjole 

 strength, while still more easy 

 to handle when iutroduced in- 

 to the bladder through the com- 

 paratively small opening of is- 

 chial urethrotomy. 



A bivalve speculum (Fig. 

 476) to dilate the wound of the 

 urethra is sometimes of great 

 value. A large syringe, and 

 plenty of water, or what is 

 better, an irrigator for douches 

 to wash out the bladder, will 

 complete the series of neces- 

 sary instruments. The opera- 

 tion is performed with the ani- 

 mal in the standing position, 

 secured as for urethrotomy, or 

 cast if the operator so prefer 

 it, and placed under the influ- 

 ence of general anesthesia. 



We borrow from H. Bou- FM- 475. -Crushing Forceps of Bouley. 

 ley, the father of the operation, his own description of the modus 

 operandi : 



Access to the bladder having been obtained by the process 

 ah-eady described, the essential operation is di\ided into three 

 principal steps : 



1st. The introduction of the hthotritor, and searching for and 

 grasping the stone ; 2d, crushing of the calciilus ; 3d, removal of 

 the fragments. 



